The Hospital to Home Study: A Pragmatic Trial to Optimize Transitions and Address Disparities in Asthma Care

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Despite evidence-based NIH guidelines for asthma, overall morbidity among children has not significantly decreased. In the US, asthma accounts for >150,000 hospitalizations, >600,000 emergency department visits, and nearly 14 million missed school days annually. Striking socioeconomic and racial inequities persist with under-resourced children incurring a disproportionate share of asthma morbidity. Our long-term goal is to improve health outcomes and reduce disparities in asthma morbidity for all children. Our team will address critical barriers to achieving broad-scale improvements in outcomes for all children hospitalized with asthma in the US, in any setting. This proposal’s overall objective is to improve asthma outcomes by conducting a patient-centered, multicomponent intervention focusing on under-resourced children with asthma at both children’s (ChH) and community hospitals (CH). Intervention components are navigation support, medications in-hand at discharge, primary care provider communication, school-based therapy, and home assessment. Leveraging feedback from stakeholders and building on the telehealth infrastructure, we will utilize a pragmatic effectiveness-implementation trial design to test the overall hypothesis that a refined version of the Hospital-to- Home (H2H) intervention will reduce asthma readmissions over a 12-month follow-up period. The hypothesis will be tested in the following aims. (1): Engage key stakeholders to identify barriers and facilitators for implementation of the components of H2H at children’s (ChH) and community hospitals (CHs). We will conduct qualitative interviews to identify barriers and facilitators and refine each component for optimal implementation. (2): Evaluate health outcomes of the H2H intervention compared to usual care control group for children hospitalized with an asthma exacerbation at ChH and CH sites. We propose a multi-center, randomized trial enrolling 340 caregiver-child (aged 4-12yrs) dyads during hospitalization to a multi-component intervention. (3): Evaluate implementation of each component of the H2H intervention and assess impact of implementation on health outcomes. We will evaluate feasibility, acceptability, and fidelity using mixed-methods to assess variation in implementation of each component across sites and their impact on health outcomes. By focusing on broader implementation at both ChHs and CHs, this innovative proposal has significant implications for improving asthma management and reducing health disparities incurred by under-resourced school-aged children. This proposal is aligned with NIH’s mission to address health disparities and will provide crucial insights in intervention implementation at all types of hospital settings that care for children. Because the hospitalization for children with asthma serves a high-risk population who may otherwise be difficult to reach, identifying the most clinically effective method by which to deliver a preventative health service is urgently needed. This work has the potential to shift current hospitalization clinical practice paradigms from only acute encounters for asthma exacerbations to the broader management of public health prevention.